MCC Certification Program

1
MCC Certification Program

• May 14, 2009
• Jamie Katz

2
MCC Determinations

• Applications for MCC Determinations
• Single applications may request determinations
  for multiple plans, resulting in both approvals
  and denials
• Numbers to date
• 262 plans approved and 11 denied (5 more plans
  awaiting denial due to cap on Rx)
• 78 applications under active review (some may be
  for multiple plans)
• 183 applications to be reviewed (some for
  multiple plans) and 132 plans from one carrier to
  be reviewed
• One consulting firm will be submitting requests
  for certification for 1,000-2,000 plans
• 40 actuarial attestations included with
  submissions
• Many determined to have no MCC deviation (no
  Connector action necessary)
• Approximately 2.5 FTEs of Connector personnel
  currently involved in the MCC determination
  process

3
MCC Determinations

• Many phone calls and e-mails with carriers,
  employers, and brokers
• Guidance given on application process and
  standards
• Organizations told not to apply if plans will not
  meet MCC (e.g., if any of the broad range
  services not met) and not to apply if their plans
  do fully meet MCC
• Examples of denials
• No Rx
• No mental health coverage

4
MCC Determinations

• Central issues
• Do plans provide robust coverage for healthcare
  services comparable to Bronze and
• Will potential financial exposure for most
  covered individuals exceed Bronze potential
  exposure?
• Recent examples of robust plans with deviations
  deemed MCC compliant
• Caps on specific preventive care services in
  plans with low or no deductibles and low or no
  OOP maximum
• Most frequently, a cap on routine adult physical
  exams of 200-500 (but not on diagnostic
  screenings)
• Mental health/substance abuse co-insurance not
  counted toward OOP maximums (2009 issue)
• Co-pays exceed 100 and not counted toward OOP
  maximum (often a separate cap on these co-pays)

5
MCC Determinations

• Recent policy issues
• Continuing, infrequent submissions by unions of
  plans intended for part-time workersmost
  recently, plans submitted have relatively low
  annual limits so do not meet MCC denial by
  Connector usually means plans scrapped
• In a small number of cases, caps on Rx exist
  (e.g., 5,000-25,00)
• Staff plans to disallow these plans, even though
  they may have a higher actuarial value than some
  of the allowed plans

6
MCC determinations

• Public concern with the standard still evident,
  but communications expressing unhappiness with
  MCC standards have dropped substantially
• Employers making significant efforts to meet MCC
  standards
• Staff is seeing a high degree of compliance
• Out of state employers also trying to accommodate
  MCC standards in many instances